The Japanese Journal of Psychiatry and Neurology, Vol. 46, No. 4, 1992
Accelerated Plethysmogram in Nursing Home Residents Itsugi Nagatomo, M.D., Mitsuo Nomaguchi, M.D. and Kei Matsumoto, M.D. Department of Neuropsychiatry, Faculty of Medicine, Kagoshima University, Kagoshima
Abstract: To investigate the peripheral blood circulation, 24 young volunteers, 28 nursing home residents with cerebrovascular diseases (CVD) and 42 residents without them were studied for accelerated plethysmogram (APG). Both residents were rated by the modified Stockton geriatric rating scale (modified SGRS) which have four aspects of impairments; physical disability, socially irritating behavior, communication failure and apathy. As to the waveform patterns of APG, the majority of the young volunteers and both the residents showed patterns B and G, respectively. Coefficient of APG (Co-APG) of the former was significantly larger than that of the latter. In the residents without CVD,Co-APG was significantly negatively correlated with physical disability and apathy of the modified SGRS. But, Co-APG did not correlate with the modified SGRS in the residents with CVD. Key Words : accelerated plethysmogram, behavioral rating scale, elderly people, cerebrovascular disease Jpn J Psychiatr Neurol 46: 891-896 1992
INTRODUCTION
The life span of the Japanese population is increasing rapidly, with the elderly constituting a growing proportion of the population. Increasing attention has recently been directed to the diagnosis and treatment in the elderly". Many chronic illnesses are known to increase with age, and individuals with one or more chronic illnesses often experience a number of psychological disturbances." We had reported the influences of urinary incontinence and treatment in hospital on psychotic features of nursing home resident^.^ lo Monitoring the status of peripheral blood circulation provides an important means of Received for publication on February 3, 1992. Mailing address: Itsugi Nagatomo, M.D., Department of Neuropsychiatry, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima 890, Japan.
evaluating the status of blood circulation. For this reason, investigations were made into fingertip pulse plethysmography which monitors variations in the amount of blood in the hyponychial capillaries. When these original waveforms are quadratically differentiated, accelerated plethysmogram (APG) which is effective information components extracted from them. This is a good index of the status of blood circulation. The Stockton geriatric rating scale (SGRS)' is one of the most famous behavioral rating scales used to assess elderly patients' behavior. Ikegami4 reported that he modified the SGRS to suit Japanese conditions (modified SGRS) and the reliability and validity of the modified SGRS were established through high correlations between the scores on it and those of the original SGRS. Despite a large number of reports of psychiatric problems in nursing home re-
I. Nagatomo et nl.
892
sidents' 13, little is known about the relationship between physical conditions and psychiatric symptoms. In the present study, we investigated the relationship between APG and the modified SGRS in nursing home residents. SUBJECTS AND METHODS Ninety-four subjects were divided into 3 groups. Group 1 consisted of 24 young volunteers (6 males; 18 females), and they ranged in age from 20 to 54 (mean age: 38.1 10.4). Group 2 comprised 28 residents with chronic cerebrovascular diseases (CVD) (6 males; 22 females), and they ranged in age from 66 to 98 (mean age: 79.5k7.6). Group 3 totaled 42 residents without CVD (3 males; 39 females), and they ranged in age from 71 to 95 (mean age: 84.3f6.3). They sat on a chair or bed, and put their fore or middle finger in the sensor of acceleration plethysmography (Precaregraph, Misawa Homes Institute, Japan) at a height of their hearts. The mechanism of this acceleration plethysmography is as follows. (1) Apply near-infrared radiation to the fingertip, and record the fingertip pulse plethysmogram. (2) Quadratically differentiate the recorded pulse waveform with respected to time. (3) The acceleration waveform has four points of inflection: a, b, c and d. Coefficient of APG (Co-APG) is determined by the heights b, c and d against the height of a. Co-APG obtained by the formula: Co-APG = ( -b c d)/a. (4) The acceleration waveform is classified into 7 patterns (A to G). The waveform patterns correspond to the following circulatory statuses. Pattern A: Usually seen in healthy young people and suggests the state of blood circulation is good. Pattern B: Appears when the state of blood circulation is good but aggravating. Pattern C: Suggests the state of blood circulation is insufficient. Patterns D, E, F and G: Suggest the state of blood circulation is rather bad. Details of Co-APG and waveform patterns of APG are described elsewhere.2 l4 l6 The modified SGRS, which eliminated 11
*
++
items (items 6,9, 17,22,25, 30, 31, 33, la, 10a, 13a) from Form I1 of the SGRS, contains 22 items which are rated by skilled nursing staff and measures four aspects of impairmentsphysical disability (7 items), socially irritating behavior ( 5 items), communication failure (3 items) and apathy (7 items), which are combined to give a total disability score. Each item has scores from 1 to 3 and high scores indicate greater impairment. Items of physical disability are concerned with the ability of the elderly to take care of his day-to-day physical needs. Items of socially irritating behavior relate to socially undesirable behavior. The elderly who did not communicate verbally were severely handicapped and likely to get high scores on items of communication failure. Items of apathy are concerned with the elderly's involvement in his ward environment. Data were analyzed using the Student's t-test and simple linear regression. RESULTS
Table 1 shows the distribution of subjects by sex and mean age. The mean age of the residents without CVD was significantly higher than that of the residents with CVD (P
Accelerated Plethysmogram in Nursing Home Residents Itsugi Nagatomo, M.D., Mitsuo Nomaguchi, M.D. and Kei Matsumoto, M.D. Department of Neuropsychiatry, Faculty of Medicine, Kagoshima University, Kagoshima
Abstract: To investigate the peripheral blood circulation, 24 young volunteers, 28 nursing home residents with cerebrovascular diseases (CVD) and 42 residents without them were studied for accelerated plethysmogram (APG). Both residents were rated by the modified Stockton geriatric rating scale (modified SGRS) which have four aspects of impairments; physical disability, socially irritating behavior, communication failure and apathy. As to the waveform patterns of APG, the majority of the young volunteers and both the residents showed patterns B and G, respectively. Coefficient of APG (Co-APG) of the former was significantly larger than that of the latter. In the residents without CVD,Co-APG was significantly negatively correlated with physical disability and apathy of the modified SGRS. But, Co-APG did not correlate with the modified SGRS in the residents with CVD. Key Words : accelerated plethysmogram, behavioral rating scale, elderly people, cerebrovascular disease Jpn J Psychiatr Neurol 46: 891-896 1992
INTRODUCTION
The life span of the Japanese population is increasing rapidly, with the elderly constituting a growing proportion of the population. Increasing attention has recently been directed to the diagnosis and treatment in the elderly". Many chronic illnesses are known to increase with age, and individuals with one or more chronic illnesses often experience a number of psychological disturbances." We had reported the influences of urinary incontinence and treatment in hospital on psychotic features of nursing home resident^.^ lo Monitoring the status of peripheral blood circulation provides an important means of Received for publication on February 3, 1992. Mailing address: Itsugi Nagatomo, M.D., Department of Neuropsychiatry, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima 890, Japan.
evaluating the status of blood circulation. For this reason, investigations were made into fingertip pulse plethysmography which monitors variations in the amount of blood in the hyponychial capillaries. When these original waveforms are quadratically differentiated, accelerated plethysmogram (APG) which is effective information components extracted from them. This is a good index of the status of blood circulation. The Stockton geriatric rating scale (SGRS)' is one of the most famous behavioral rating scales used to assess elderly patients' behavior. Ikegami4 reported that he modified the SGRS to suit Japanese conditions (modified SGRS) and the reliability and validity of the modified SGRS were established through high correlations between the scores on it and those of the original SGRS. Despite a large number of reports of psychiatric problems in nursing home re-
I. Nagatomo et nl.
892
sidents' 13, little is known about the relationship between physical conditions and psychiatric symptoms. In the present study, we investigated the relationship between APG and the modified SGRS in nursing home residents. SUBJECTS AND METHODS Ninety-four subjects were divided into 3 groups. Group 1 consisted of 24 young volunteers (6 males; 18 females), and they ranged in age from 20 to 54 (mean age: 38.1 10.4). Group 2 comprised 28 residents with chronic cerebrovascular diseases (CVD) (6 males; 22 females), and they ranged in age from 66 to 98 (mean age: 79.5k7.6). Group 3 totaled 42 residents without CVD (3 males; 39 females), and they ranged in age from 71 to 95 (mean age: 84.3f6.3). They sat on a chair or bed, and put their fore or middle finger in the sensor of acceleration plethysmography (Precaregraph, Misawa Homes Institute, Japan) at a height of their hearts. The mechanism of this acceleration plethysmography is as follows. (1) Apply near-infrared radiation to the fingertip, and record the fingertip pulse plethysmogram. (2) Quadratically differentiate the recorded pulse waveform with respected to time. (3) The acceleration waveform has four points of inflection: a, b, c and d. Coefficient of APG (Co-APG) is determined by the heights b, c and d against the height of a. Co-APG obtained by the formula: Co-APG = ( -b c d)/a. (4) The acceleration waveform is classified into 7 patterns (A to G). The waveform patterns correspond to the following circulatory statuses. Pattern A: Usually seen in healthy young people and suggests the state of blood circulation is good. Pattern B: Appears when the state of blood circulation is good but aggravating. Pattern C: Suggests the state of blood circulation is insufficient. Patterns D, E, F and G: Suggest the state of blood circulation is rather bad. Details of Co-APG and waveform patterns of APG are described elsewhere.2 l4 l6 The modified SGRS, which eliminated 11
*
++
items (items 6,9, 17,22,25, 30, 31, 33, la, 10a, 13a) from Form I1 of the SGRS, contains 22 items which are rated by skilled nursing staff and measures four aspects of impairmentsphysical disability (7 items), socially irritating behavior ( 5 items), communication failure (3 items) and apathy (7 items), which are combined to give a total disability score. Each item has scores from 1 to 3 and high scores indicate greater impairment. Items of physical disability are concerned with the ability of the elderly to take care of his day-to-day physical needs. Items of socially irritating behavior relate to socially undesirable behavior. The elderly who did not communicate verbally were severely handicapped and likely to get high scores on items of communication failure. Items of apathy are concerned with the elderly's involvement in his ward environment. Data were analyzed using the Student's t-test and simple linear regression. RESULTS
Table 1 shows the distribution of subjects by sex and mean age. The mean age of the residents without CVD was significantly higher than that of the residents with CVD (P
